Recipient Comorbidities for Prediction of Primary Graft Dysfunction, Chronic Allograft Dysfunction and Survival After Lung Transplantation

Abstract

Since candidates with comorbidities are increasingly referred for lung transplantation, knowledge about comorbidities and their cumulative effect on outcomes is scarce. We retrospectively collected pretransplant comorbidities of all 513 adult recipients transplanted at our center between 1992–2019. Multiple logistic- and Cox regression models, adjusted for donor-, pre- and peri-operative variables, were used to detect independent risk factors for primary graft dysfunction grade-3 at 72 h (PGD3-T72), onset of chronic allograft dysfunction grade-3 (CLAD-3) and survival. An increasing comorbidity burden measured by Charleston-Deyo-Index was a multivariable risk for survival and PGD3-T72, but not for CLAD-3. Among comorbidities, congestive right heart failure or a mean pulmonary artery pressure >25 mmHg were independent risk factors for PGD3-T72 and survival, and a borderline risk for CLAD-3. Left heart failure, chronic atrial fibrillation, arterial hypertension, moderate liver disease, peptic ulcer disease, gastroesophageal reflux, diabetes with end organ damage, moderate to severe renal disease, osteoporosis, and diverticulosis were also independent risk factors for survival. For PGD3-T72, a BMI>30 kg/m2 was an additional independent risk. Epilepsy and a smoking history of the recipient of >20packyears are additional independent risk factors for CLAD-3. The comorbidity profile should therefore be closely considered for further clinical decision making in candidate selection.

A novel nomogram for predicting prolonged mechanical ventilation in lung transplantation patients using extracorporeal membrane oxygenation

“…However, Intraoperative and postoperative ECMO prolongation can be associated with worse outcomes such as bleeding complications, systemic inflammatory response, acute kidney injury, and thromboembolic complications 19 , 20 , There is no consensus on the Intraoperative ECMO prolongation. The prolongation of the operation time reflects the high difficulty of the operation, which passively prolongs the application time of ECMO 21 . In summary, it affects the prognosis of LTx patients.…”

Donor and recipient risk factors for the development of primary graft dysfunction following lung transplantation

“…Specific recipient diagnoses portend more risk of developing PGD postoperatively. Pulmonary hypertension, IPF, diastolic dysfunction, and sarcoidosis have been shown to be associated with development of PGD ( 45 , 67 , 74 – 76 ).…”

Primary graft dysfunction after lung transplantation

“…Recipient risk factors implicated in the development of PGD include female sex, African–American race, obesity (BMI >30 kg/m 2 ), preoperative right ventricular dysfunction and higher pulmonary artery pressures postreperfusion (mean >25, systolic >41) [40 ▪ ,41 ▪ ]. Importantly, there is no association between recipient age and PGD [42,43 ▪ ]. Recipient diagnoses consistently shown to increase the risk of PGD include pulmonary arterial hypertension, idiopathic pulmonary fibrosis and sarcoidosis [42,44].…”